Hypospadias is categorised based on where the urethra opens (the canal by which urine is removed from the body). It can be broadly classified as anterior or posterior based on the location of the urinary meatus. More precise classification, as per the location of the meatus is as follows:
| Hypospadias Types | Location of Urethral Opening | What is Happening? | |
|
Distal |
Glanular | On the head of the penis, but not at the very tip | Mildest type; the opening is slightly lower than normal. |
| Coronal | Just below the head of the penis, or where the head meets the shaft | The most common type, the opening is near the edge of the head. | |
| Sub coronal | Below the junction between the head of the penis and the shaft | Common type of hypospadias | |
| Mid penile |
Midshaft | Halfway down the shaft of the penis | The opening is along the middle portion of the penis. |
|
Proximal |
Penoscrotal | Where the penis and scrotum meet | The opening is at the junction between the penis and scrotum. |
| Scrotal/ Perineal |
On or below the scrotum | Most severe type; opening is very low, sometimes behind the scrotum. | |
Note: They can be mild to severe based on the degree of the bend in the penis, the location of the urinary opening and the foreskin abnormality.
According to Dr Satej Shankar Mhaskar, who has a total of 17 years of experience, hypospadias has following major causes:
It can happen due to a mix of many factors, such as genes and environment working collectively, rather than a single clear cause. These combined effects disturb the normal penile development of the fetus during pregnancy.
Endocrine-disrupting chemicals (EDCs) in the environment, especially those that affect hormones, can interfere with fetal genital formation. These are estrogenic environmental pollutants like phthalates, phytoestrogens and myco-oestrogens. Exposure to harmful chemicals like Benzophenone-2, an additive in cosmetic products, can be a risk factor for hypospadias.
Abnormal changes or mutations in certain genes, such as Hoxd13, HOXA13, SHH, GL1, etc, that guide the formation of the male urethra can disrupt normal growth signals. These can lead to hypospadias.
A family history of hypospadias or associated genital conditions can pass on abnormal genes to the next generation. This can play a role in increasing the chance of this condition in newborns.
It is generally easy to diagnose because the urethral opening/meatus isn’t at the tip of the penis.
It is uncommon to detect it during regular pregnancy scans. This is because the genital abnormalities might not be clearly visible for diagnosis before birth.
Generally, hypospadias is detected immediately after birth during a physical examination that a Paediatrician performs. They see if the urethral opening is at the tip of the penis or not.
Parents often identify the abnormal position of the urinary opening or other genital abnormalities when changing the baby at home.
If hypospadias is diagnosed in the newborn, prompt treatment is required. Because if left untreated, children may face the following symptoms.
Hypospadias symptoms can be as follows:
| Life Stage | Hypospadias Symptoms |
| Infantile | ● Usually no symptoms, and rarely, straining to pass urine if the urinary opening is smaller. |
| School age | ● Not able to direct the stream in the toilet. ● Not able to pass urine in the standing position. ● Spraying when passing urine. ● Urinary stream following on the feet. |
| Adolescent | ● Penile curvature (penis bends to one side during an erection) ● Cosmesis and psychological concerns due to the appearance |
| Adulthood | ● Difficulties in sexual life due to penile curvature |
Note: Most of the children do not experience any symptoms in the infantile period.
Aims of the management are to achieve:
Surgery (hypospadias repair) is usually an outpatient procedure, and most Paediatric urologists perform a hypospadias repair when the child is 12 -18 months old.
During the surgery or hypospadias repair, the Paediatric urologist will aim to:
According to him, there are many different surgical procedures performed to manage hypospadias.
The selection of the procedure will depend on:
Generally, patients need 1-3 surgeries based on the type and severity of hypospadias. And a urinary catheter and dressing are generally needed for 7 days.
Hypospadias repair is a safe and effective procedure when done by a professional like Dr. Satej Shankar Mhaskar (Consultant - Peadiatric Surgery and Peadiatric Urology) at Surya Hospitals, Santacruz. However, like any other surgery, there are some rare risks:
The recovery depends on the severity and complexity of the condition; however, full recovery takes about 6 to 8 weeks after a hypospadias repair.
Sometimes, growth and development can be challenging for a baby. Hence, as parents, it is your responsibility to ensure your baby grows healthily. If you notice any abnormalities like hypospadias, seek timely, reliable medical care at Surya Hospitals Santacruz (known for the best hypospadias surgery in Mumbai). Early diagnosis and treatment help your child lead a happy, healthy life and enjoy a normal and joyous adulthood.
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